Scope of Services
Capturing charges properly is a critical process to providers.
It drives contract negotiation, billing, and cost containment initiatives.
Proper charge capture is a necessary step in compliant and patient
Charge Description Master (CDM) Services
PCS' CDM services verify the accuracy and completeness of itemized
charges within the hospital's CDM, and decrease potential exposure
to compliance issues. Providers can select from a variety of CDM
- Immediate Desk-top Updates
- Quarterly Maintenance Agreements
- Comprehensive On-site Reviews
- On-site installation of proprietary CDM analytical tool
The key to quality patient care and appropriate reimbursement
is complete and specific clinical documentation. The translation
of clinical documentation to coded data is never a simple task.
Whether services are acute care, rehabilitation or psychiatry, most
facilities have opportunities for documentation improvement.
PCS' coding and documentation reviews identify coding and compliance
errors by screening and reviewing both inpatient and outpatient
claims and medical records. By assigning the proper APC (Medicare)
and DRG (Medicare & Non-Medicare) codes to a patient record, our
clients can expect these results:
- Improved Revenue and Profitability
- Reduced Operation Costs
- Decreased Compliance Exposure
Today's healthcare providers face a dizzying array of new regulations
and increased enforcement actions designed to combat fraud and abuse.
As federal and state authorities multiply their efforts to scrutinize
billing, it has never been more important for providers to identify
areas of compliance weakness and develop solutions before these
Education & Training
PCS regularly provides educational programs for healthcare providers
and coders including on-site and off-site workshops, teleconferences,
and web conferences. All of our educational services offer the most
up-to-date information available and frequently include case studies
based on our hands-on experience.
Inpatient CMI Improvement
Inpatient services account for the largest portion of hospital
costs and related reimbursement. PCS has a proven track record assisting
acute facilities increase their CMI and revenue through improved
clinical documentation and compliance. Communication becomes transparent
when physicians and coders, working as a team, understand what is
needed to reach new heights. Additionally, Sentinel InpatientTM
offers a way for your facility to identify opportunities and issues
on a continuous basis.
PCS' services include the rebilling of paid claims for a hospital
to correct errors or omissions in the coding of a patient record
to the insurance companies. Our clients' experiences with correct
reporting have these results:
- Identified Billing Errors and Omissions to correct on an
- Improved Compliance, and
- Significant Revenue Opportunities
Recovery Audit Contractor (RAC)
Contending with this new regulatory entity requires a comprehensive,
team-based approach. Our team has:
- Credentialed coders and compliance professionals who will
work closely with your RAC team
- First hand experience helping many healthcare providers
with RAC during the demonstration project
- Success built on delivering measurable solutions to today's
Reimbursement Analysis, Cost Report Reviews & Rate Appeals
PCS' reimbursement analysis services are designed to protect
and enhance the client's bottom line by recovering full payment
through the following services:
- Disproportionate Share Adjustment (DSH)
- Medicare and Medicaid Rate Review and Appeals
- Third Party Reimbursement and Cost Report Preparation and
Healthcare providers operate in a complex financial environment.
They must be fluent in multiple coding methodologies (ICD-9-CM,
HCPCS, CPT-4) and comply with different and sometimes conflicting
third party payer regulations...all of which is constantly changing.
Making sense of it all is easier with PCS on your side.
SentinelTM Product Suite
Choose from or use together - SentinelTM
Outpatient and SentinelTM Inpatient. PCS offers healthcare providers a web-based tool for comprehensive
revenue cycle management. In addition, each SentinelTM
be outsourced to save you time. The underlying logic of SentinelTM
is based on our extensive experience assisting hospitals to
identify and correct coding, charging, and billing inaccuracies.
SentinelTM prioritizes each edit by the likelihood of
change and expected fiscal impact, thereby enabling users to easily
focus on those issues with significant compliance or potential fiscal
Strategic Pricing & Charge Analysis Services
PCS' Pricing and Charge Analysis services examine existing pricing
and charge structures to maintain a competitive, rational, and sustainable
pricing model to assure appropriate reimbursement across all payers.
Our engagements are designed to take into account market value,
competitive pricing, and corresponding reimbursement-related issues.